Abstract 15230: Ross Procedure in Children
Introduction: Aortic root dilatation is of concern after Ross procedure and may result in reoperation. To prevent dilatation of the neo-aortic root, but permit normal growth, we recently began to apply re-absorbable polydioxanone suture (PDS) band at sino-tubular (ST) junction.
Hypothesis:Ross procedure in children < 1 year of age carries higher mortality and reoperation rate. Stabilization of ST junction may decrease progression of neo-aortic root dilatation.
Methods: All children (n=99) who underwent Ross procedure at the Royal Children's Hospital during 1995-2012 period were retrospectively studied.
Results:Mean age at Ross procedure was 8.6 ± 1.2 years (median 8.3 years, range 3 days - 20 years); 19 patients were < 1 year of age. The root replacement (n=91, including Ross-Konno procedure in 29 patients), root inclusion (n=5), and sub-coronary implantation (n=3) techniques were used. Operative mortality was 6% (6/99, 4 neonates, 2 infants). Age of < 1 year at time of operation was a risk factor for early death (p < 0.001). Mean follow-up time was 7.0 ± 1.0 years (median 7.0 years, range 5 days - 16 years). Late mortality was 4%(4/93). Freedom from moderate or greater neo-aortic valve insufficiency (AI) at 5, 10, 15 years was 95%, 93% and 88%, respectively. Freedom from neo-aortic valve reoperation at 5, 10, 15 years was 97%, 89% and 83%, respectively. All neo-aortic reoperations were secondary to AI. Aortic dilatation to z-score >4 was greatest at ST junction (22%,9/41) compared to aortic annulus (12%,5/41) and sinuses (10%,4/41). Only 5% (2/41) had z-score > 4 in all 3 dimensions. Since 2001, a PDS band was placed around ST in 18 patients. They were compared with matched patients without PDS band (n=36) operated during the same period. Patients with PDS band had less AI (0 vs 11%), reoperation (0 vs 3%), late mortality (0 vs 3%), but this trend did not reach statistical significance at 3.5 + 1.2 years.
Conclusions:Ross procedure in children can be performed with acceptable results. Children < 1 year of age have high mortality, but not re-operation rate. Stabilization of ST junction may reduce progression of neo-aortic root dilatation long-term.
- © 2012 by American Heart Association, Inc.